Teaching LGBTQ+ Health, a Web-Based Faculty Development Course: Program Evaluation Study Using the RE-AIM Framework

Background Many health professions faculty members lack training on fundamental lesbian, gay, bisexual, transgender, and queer (LGBTQ+) health topics. Faculty development is needed to address knowledge gaps, improve teaching, and prepare students to competently care for the growing LGBTQ+ population. Objective We conducted a program evaluation of the massive open online course Teaching LGBTQ+ Health: A Faculty Development Course for Health Professions Educators from the Stanford School of Medicine. Our goal was to understand participant demographics, impact, and ongoing maintenance needs to inform decisions about updating the course. Methods We evaluated the course for the period from March 27, 2021, to February 24, 2023, guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. We assessed impact using participation numbers, evidence of learning, and likelihood of practice change. Data included participant demographics, performance on a pre- and postcourse quiz, open-text entries throughout the course, continuing medical education (CME) credits awarded, and CME course evaluations. We analyzed demographics using descriptive statistics and pre- and postcourse quiz scores using a paired 2-tailed t test. We conducted a qualitative thematic analysis of open-text responses to prompts within the course and CME evaluation questions. Results Results were reported using the 5 framework domains. Regarding Reach, 1782 learners participated in the course, and 1516 (85.07%) accessed it through a main course website. Of the different types of participants, most were physicians (423/1516, 27.9%) and from outside the sponsoring institution and target audience (1452/1516, 95.78%). Regarding Effectiveness, the median change in test scores for the 38.1% (679/1782) of participants who completed both the pre- and postcourse tests was 3 out of 10 points, or a 30% improvement (P<.001). Themes identified from CME evaluations included LGBTQ+ health as a distinct domain, inclusivity in practices, and teaching LGBTQ+ health strategies. A minority of participants (237/1782, 13.3%) earned CME credits. Regarding Adoption, themes identified among responses to prompts in the course included LGBTQ+ health concepts and instructional strategies. Most participants strongly agreed with numerous positive statements about the course content, presentation, and likelihood of practice change. Regarding Implementation, the course cost US $57,000 to build and was intramurally funded through grants and subsidies. The course faculty spent an estimated 600 hours on the project, and educational technologists spent another 712 hours. Regarding Maintenance, much of the course is evergreen, and ongoing oversight and quality assurance require minimal faculty time. New content will likely include modules on transgender health and gender-affirming care. Conclusions Teaching LGBTQ+ Health improved participants’ knowledge of fundamental queer health topics. Overall participation has been modest to date. Most participants indicated an intention to change clinical or teaching practices. Maintenance costs are minimal. The web-based course will continue to be offered, and new content will likely be added.


Q1. Please assess your knowledge of LGBTQ+ health content. (This item is not scored)
• I have never heard of this content.
• I have heard of this content but don't understand it.
• I have some understanding of this content.
• I understand this content quite well.
• I understand this content and could explain it to others.

Answer: (Item not scored, correct is always the response.)
Thank you for your response. Please advance to the next question.

Q2. Please assess your ability to teach LGBTQ+ health content. (This item is not scored)
• I cannot teach this content.
• I would like to teach this content, but I don't know how to.
• I have a basic understanding of how to teach this content but do so rarely.
• I am confident enough to teach this content occasionally.
• I teach this content regularly.
Answer: (Item not scored, correct is always the response.) Thank you for your response. Please advance to the next question.
Q3. Which of the following statements about LGBTQ+ health curricula at US medical schools is FALSE? (Choose all that apply.) • Guidance from the Association of American Medical Colleges (AAMC) is inadequate.
• LGBTQ+ health content is included in 60% of US medical school curricula.
• Medical student demand for LGBTQ+ health curricula is high.
• Professional societies call for improved teaching of LGBTQ+ health.

Answer: "Guidance from the Association of American Medical Colleges (AAMC) is inadequate" and "
LGBTQ+ health content is included in 60% of US medical school curricula" are not accurate statements. In 2014, the AAMC called for improvements to medical school climate and curriculum in a landmark publication that described core competencies for LGBTQ+ health education. However, LGBTQ+ health curricula are limited or non-existent at many US medical schools.

Location in Course: Introduction
This question tests knowledge of: the educational gap between demand for LGBTQ+ health content and expected faculty teaching competency. Suggested Teaching Strategy: Curriculum Design. Seek opportunities to include LGBTQ+ health content in your clinical teaching and your school's curriculum.

Q4. Which of the following statements is FALSE? (Choose all that apply.)
• A gay male may be sexually or romantically attracted to a transmasculine person.
• "Lesbian" is a term that a patient may use to describe their gender identity.
• "Queer" is a term that may be used to describe gay men, lesbians, and/or transgender people. • "Transfeminine" is a term that describes a person assigned the male sex at birth and who identifies as a woman or feminine non-binary person.
Answer: "Lesbian" is a term that a patient may use to describe their gender identity. "Lesbian" is a term that describes the sexual orientation of women who are mostly or exclusively attracted to other women. It does not explicitly describe an individual's gender. While gay men are generally attracted to other men, they may not be exclusively attracted to men. "Queer" is a reclaimed, positive, and inclusive term for all individuals who identify within the LGBTQ+ community, despite its historical use as a pejorative slur. "Transfeminine" and "transmasculine"-often abbreviated as "trans"-refer to a current gender expression that does not traditionally align with sex assignment at birth.

Location in Course: LGBTQ+ vocabulary/glossary
This question tests knowledge of: LGBTQ+ vocabulary.
Suggested Teaching Strategies: Proper use of these terms presents an opportunity to connect with LGBTQ+ patients by treating them with dignity and respect-and this is a great teaching point to emphasize to your students who are unfamiliar with this material.
Here are three strategies for teaching LGBTQ+ terminology: Item Writing. Use multiple-choice or true/false questions to confirm student knowledge of LGBTQ+ vocabulary. Curriculum Design. Use terms such as "Queer Health" and "LGBTQ+ Health" in your course syllabus. Clinical Teaching. Distinguish between gender, sexual orientation, and sex assignment at birth. Do not use the word "preferred" to describe a patient's gender, gender pronouns, or sexual orientation. Distinguish between gender, sexual orientation, and sex assignment at birth. Do not use the word "preferred" to describe a patient's gender, gender pronouns, or sexual orientation.

Q5. Which of the following social determinants of queer/trans health result in DECREASED utilization of primary care among LGBTQ+ patients? (Choose all that apply.)
• Familial Rejection

Location in Course: Social and Behavioral Determinants of LGBTQ+ Health
This question tests knowledge of: social determinants of LGBTQ+ health.

Suggested Teaching Strategy: Clinical Teaching. Review social and behavioral determinants of
LGBTQ+ healthcare utilization when teaching students in your clinical practice.
Q6. Which of the following statements describing determinants of health care accessibility among LGBTQ+ individuals is TRUE? (Choose all that apply.) • Intersecting minority identities have a synergistic effect on minority stress.
• Prevalence of substance use by sexual and gender minorities mirrors the general US population. • Sexual and gender minority women access primary care similarly to other women.
• Unmarried domestic partners are considered legal health care proxies in all US states.
Answer: Intersecting minority identities have a synergistic effect on minority stress. Minority stress affects patient well-being and risks decreased engagement with health care providers. More than one minority status results in additive stress and increased health disparities.

Locations in Course: Social and Behavioral Determinants of LGBTQ+ Health, Case: Carla
This question tests knowledge of: social and behavioral determinants of LGBTQ+ healthcare utilization.
Suggested Teaching Strategy: Item Writing. Design multiple-choice, true/false, or essay questions that test student knowledge of various determinants of queer health. Use correct LGBTQ+ vocabulary in the stem of the question and the foils.

Q7. 'The 5 P's of Sexual Health' include all of the following EXCEPT:
• Partners • Past sexually-transmitted infections • Positions • Practices • Pregnancy Choices • Protection from sexually-transmitted infections Answer: Positions. The 5 P's of Sexual Health is a framework for obtaining a sexual history. One of the 5 questions prompts discussion of sexual practices, not positions. It is important to ask about sexual practices in order to specifically address the risks of sexually transmitted infections.

Locations in Course: Teaching Strategies, Case: Jesse
This question tests knowledge of: important elements of a sexual history.
Suggested Teaching Strategy: Role Modeling. Demonstrate using the '5 P's of Sexual Health' when teaching students how to obtain a sexual history during a patient interview. Your students may be uncomfortable with this technique initially. Role model the technique for them, observe their performance and provide feedback during your debriefing.
Q8.You are caring for a serodiscordant gay couple. The patient who is HIV+ positive is compliant with HAART (Highly Active Anti Retroviral Therapy) and has an undetectable HIV viral load. Your trainee uses the '5 P's of Sexual Health' technique of obtaining a sexual history, learns that the couple does not use condoms during penetrative anal sex, and asks you about HIV prevention counseling. What is the risk of HIV transmission for this couple?
Answer: 0% In accordance with the PARTNER2 study, when the HIV+ partner has an undetectable viral load, the risk of HIV transmission to the HIV-partner is effectively 'no risk'. • All transgender individuals seek gender-affirming medications and surgical interventions.

Locations in
• Transgender individuals seek primary care as frequently as other individuals.
• Transmasculine patients seek cervical cancer screening as frequently as other individuals.